Abstract
ObjectiveThe clinical benefits of simultaneous implant placement and soft tissue augmentation using different treatment modalities are unclear. The current meta-analysis aimed to compare the effect of simultaneous soft tissue augmentation using subepithelial connective tissue graft (SCTG) around immediate or delayed dental implant placement with other treatment modalities on the peri-implant tissue health and esthetic.MethodsUp to May 2021, four databases (PubMed, EMBASE, Cochrane Central, and Google Scholar) were searched. Randomized control trials with follow-up >3 months, evaluating simultaneous implant placement (immediate or delayed) and soft tissue augmentation using SCTG compared with other treatment modalities were included. The predictor variables were SCTG versus no augmentation with/without guided bone regeneration (GBR) or other augmentation techniques (Acellular dermal matrix (ADM), Xenogeneic collagen matrix (XCM). The outcome variables were buccal tissue thickness (BTT), mid-buccal gingival level (MGL), marginal bone loss (MBL), and pink esthetic scores (PES). Cumulative mean differences (MD) and 95% confidence interval (CI) were estimated.ResultsTwelve studies were included. SCTG along with immediate implant placement (IIP) or delayed implant placement (DIP) showed a statistically significant improvement in BTT (Fixed; MD, 0.74; 95% CI, 0.51; 0.97), MGL (Fixed; MD, 0.5; 95% CI, 0.21; 0.80), PES (Fixed; MD, 0.79; 95% CI, 0.29; 1.29), and less MBL (Fixed; MD, -0.11; 95% CI, -0.14; -0.08) compared to no graft (P<0.05). A statistically insignificant differences in BTT (Random; MD, 0.62; 95% CI, -0.41; 1.65), MGL (Fixed; MD, -0.06; 95% CI, -0.23; 0.11), MBL (Fixed; MD, 0.36; 95% CI, -0.05; 0.77) and PES (Fixed; MD, 0.28; 95% CI, -0.10; 0.67) was observed when SCTG along with DIP was compared with no augmentation plus GBR. Similarly, no statistically significant difference was observed when comparing SCTG along with DIP with acellular dermal matrix (ADM) concerning BTT (MD:0.71, P = 0.18) and KMW (MD: 0.6, P = 0.19).ConclusionThere is a very low quality of evidence to provide recommendations on whether simultaneous dental implant placement (IIP or DIP) and soft tissue augmentation using SCTG is superior to no augmentation or is comparable to the other tissue augmentation materials in improving the quality and quantity of peri-implant tissues. Therefore, further, well-designed RCTs with larger sample sizes and long follow-up times are still needed.
Highlights
Dental implants are widely used for the replacement of missing teeth
There is a very low quality of evidence to provide recommendations on whether simultaneous dental implant placement (IIP or delayed implant placement (DIP)) and soft tissue augmentation using subepithelial connective tissue graft (SCTG) is superior to no augmentation or is comparable to the other tissue augmentation materials in improving the quality and quantity of peri-implant tissues
SCTG showed a statistically insignificant difference in the mid-buccal gingival level (MGL) compared to no graft (Random; mean differences (MD), 0.09; 95% confidence interval (CI), -0.95, 0.93, P = 0.83)
Summary
Dental implants are widely used for the replacement of missing teeth. Recently, osseointegration around dental implants comes to be a foreseeable procedure; the focus has been shifted from obtaining osseointegration to achieve a satisfying aesthetic appearance [1, 2]. Sometimes the placement of the dental implant in the esthetic zone either into healed bone or into the extraction socket is associated with esthetic problems especially for patients who show their maxillary gingival scallop while smiling or talking [5]. Simultaneous soft tissue augmentation at the time of dental implant placement using subepithelial connective tissue graft (SCTG) [9] or other substitutes such as xenogenic collagen matrix (XCM) [10, 11], acellular dermal matrix (ADM) [12] has been recommended to reduce crestal bone loss in a patient with thin gingival biotype [13, 14], to prevent mid-facial mucosal recession [14, 15], to avoid shimmering through implant parts, especially those made of titanium [16]
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